Perceived Factors Associated With Susceptibility To Candidiasis Among Female Undergraduate Students In Babcock University

Health Education Project Material

Perceived Factors Associated With Susceptibility To Candidiasis Among Female Undergraduate Students In Babcock University


Abstract


Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida. Some species of Candida can cause infection in people; the most common is Candida albicans. Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems. (Sobel, et al, 2007).
The purpose of the study is to assess the factors contributing to perceived factors associated with susceptibility to candidiasis among female undergraduate students in babcock university

The study design used was an analytical cross-sectional design which utilized quantitative method of data collection. The sample size of 60 respondents was employed, achieved through simple random sampling.
The study found out that there were relationships between social-demographic characteristics and prevalence of candidiasis, most of the female undergraduates (80%) had some awareness about candidiasis and majority of the respondents (75%) had good practices towards the prevention and reducing the prevalence of candidiasis
There is a great need for health education by health workers to explain to the female undergraduates’ issues concerning their health and also emphasize proper test and confirm the diagnoses of diseases and give full treatment for the diagnosed cases.


Chapter One


1.0 Introduction

This study was aimed at establishing the perceived factors associated with susceptibility to candidiasis among female undergraduate students in Babcock university. This chapter comprises of the following sections; Background, statement of the problem, general objectives, specific objectives, research questions and justification.


1.1 Background Information

Fungal infections have become a major problem in hospitals, and the number of episodes of sepsis caused by fungi has been increasing since the early 1990s. Candida spp. remains the most common cause of invasive fungal infections, and the incidence of candidemia, which is estimated at 72.8 cases per million inhabitants and year, clearly exceeds that of invasive aspergillosis and mucormycosis. Candidemia is a consequence of advances in health care. During the last 20 years, we have observed an improvement in diagnostic procedures, the development and commercialization of new antifungal agents, and the implementation of strategies to prevent candidemia; nevertheless, the incidence of candidemia has increased(Bang R.A et al).

Candidemia is generally diagnosed using blood cultures, although diagnosis remains a challenge for clinicians and microbiologists; in fact, half of all cases of invasive Candida infections go undetected in blood cultures. Given these limitations, the true epidemiology and incidence of invasive candidiasis is imprecise. The incidence of candidemia expressed as cases per 100 000 inhabitants has been reported to range from 1 to 8 cases; in a study carried out in Brazil, incidence reported as cases per 100 000 admissions was higher (249 cases per 100 000 admissions). In a recent 1-year population-based study conducted in Spain (29 hospitals, 773 cases), the incidence of candidemia was 8.1 cases per 100 000 inhabitants, which is similar to that reported in other European studies.

Candidemia has an attributable mortality of 15–35% for adults and 10–15% for neonates, and the hospitalization cost for each episode is approximately US$40 000(Desai V.K). The rates of early and late mortality (7 days and 30 days after diagnosis, respectively) are different (13% vs. 30%). Whereas early mortality is associated with factors such as appropriate antifungal therapy and early removal of central venous catheters, late mortality is associated with factors related to the baseline condition of the host. The mortality rate is clearly correlated with a delay in the initiation of appropriate antifungal treatment. Incorrect treatment includes absence of antifungal treatment, a delay in initiation, or the use of an inactive agent. Therefore, efforts to minimize these three situations should help to reduce the mortality of candidemia. Knowledge of the frequency of causative species would facilitate appropriate selection of empirical antifungal treatment.

The distribution of Candida spp. causing candidemia varies in population-based studies carried out in different geographical areas(Foxman B). Furthermore, notable differences can also be observed between hospital units. However, the frequency of Candida species causing candidemia is also dependent on the predisposing conditions of the patients infected, the antifungal agents they receive, and the local hospital-related factors.(Stephenson R, Koenig M.A, and Ahmed S)

Main drivers of fungal diseases in Africa include the human immunodeficiency (HIV) and tuberculosis (TB) syndemic, poverty, and the growing number of individuals with non-communicable diseases, notably cancer, asthma, and diabetes mellitus. It is noteworthy that > 25 million (~70%) out of the estimated 37.9 million people living with HIV (PLHIV) worldwide are in Africa.

Despite the popularity of antiretroviral therapy (ART), cryptococcosis, pneumocystosis, histoplasmosis, and other opportunistic fungal infections continue to threaten the lives of PLHIV, particularly those who present with advanced HIV disease or failed their ART. Moreover, the fungal neglected tropical diseases (FNTD), notably mycetoma, chromoblastomycosis, sporotrichosis, and dermatophytosis occur in areas with poverty.

The spectrum of fungal diseases has posed a heavy burden on Africa which differs in one way or the other from the global statistics. However, the epidemiology of fungal diseases in Africa is not understood completely. This is mainly due to the challenges related to the availability of and access to fungal diagnostics and the lack of human resources in clinical and diagnostic mycology across the continent.

Definitive diagnosis of fungal disease requires confirmation of the causative pathogen through culture and microscopy, histopathology, immunodiagnostics, biomarkers, molecular assays, and advanced molecular detection, alone or in combination. In many parts of Africa, this is practically hampering accurate evaluation of the incidence of fungal infections.

As practicing mycologists in Africa, we are faced with several endemic, epidemic, emerging, and re-emerging fungal diseases requiring correct identification and appropriate treatment. This article aimed to highlight the key fungal diseases, their methods of diagnosis, and the challenges in Africa.

Although the epidemiology of fungal diseases has greatly changed over the past few decades, Aspergillus, Candida, Cryptococcus species, Pneumocystis jirovecii, endemic dimorphic fungi such as Histoplasma capsulatum and Mucormycetes remain the main fungal pathogens responsible for the majority cases of serious fungal disease. Candida albicans is the main agent responsible for mucosal disease, Aspergillus fumigatus for most allergic fungal disease and Trichophyton spp., especially T. rubrum, for skin infections.

In the last four years, the Leading International Fungal Education (LIFE) portal has facilitated the estimation of the burden of serious fungal infections country by country for over 5.7 billion people (>80% of the world’s population). These studies have shown differences in the global burden between countries, within regions of the same country and between at risk populations.

Global estimates, with individual country breakdowns, have been estimated for chronic pulmonary aspergillosis after pulmonary tuberculosis and complicating sarcoidosis, of allergic bronchopulmonary aspergillosis complicating asthma and cystic fibrosis, Aspergillus bronchitis complicating cystic fibrosis and mostly recently a revised estimate of cryptococcal meningitis in AIDS and recurrent vulvovaginal candidiasis (Guzel, AB 2017).. However, a precise estimate of global prevalence and incidence for each fungal infection remains unknown and, data are scanty most countries, especially in the developing word.

Knowledge about the global incidence of fungal diseases has been impaired by lack of regular national surveillance systems, no obligatory reporting of fungal diseases, poor clinician suspicion outside specialised units, poor diagnostic test performance (especially for culture) and few well-designed published studies. Some fungal diseases are only recently recognised.

Over 80% of patients could be saved from dying with universal availability of fungal diagnostics and potent antifungals agents, based on well documented treatment response rates. However, the early recognition and management of serious fungal infections is always a challenge, but especially in resource-limited settings as many conventional diagnostics tests are slow, antifungal treatment can be expensive and/or toxic and is not equally available in all countries. Other factors impinging on better outcomes include patient compliance with long-term treatment, drug-drug interactions, limited clinical experience of excellent care in many settings and co-morbidities reducing the potential for survival and cure.

In a 6-month study on candidiasis among non-pregnant women aged 15–45 years with and without clinical signs and symptoms of vulvovaginal discomfort in Gwagwalada, Nigeria. Paired high vaginal swab (HVS) andendo cervical swab(ECS) samples were collected from each of the 200 participating subjects and analyzed for isolation and identification of both C. albicans and nonalbicansCandidaspp.Of the 200 subjects recruited, 28 had Candida-positive cultures from both HVS and ECS samples, making the prevalence of candidiasis 14.0% (Infunanya, 2015). About 75% of women have at least one yeast infection at some point in their lives while nearly half have at least twice (womenshealth.gov, 2017). About 5% have more than three infections in a single year (Egan, 2021).


1.2 Statement of the Problem

About 75% of women will experience at least one episode of Candidiasis during their lifetime. In fact, 70%–75% of healthy adult women have at least one episode of candidiasis during their reproductive life, and half of college women will by the age of 25 years have had one episode of candidiasis diagnosed by a physician (Pirotta, 2012).
Over the past several decades, the number of fungal infections, caused by yeast has dramatically increased, among them, the imperfect yeast, Candida albicans and several related Candida species are of foremost importance as opportunistic pathogens in immune compromised hosts and may cause life threatening infections. Their incidence has greatly increased with the introduction of broad-spectrum antibiotics, immunosuppressive corticosteroids and anti-tumor agents.

Candida albicans is the yeast pathogen most frequently isolated from patients with virginitis. Recently, other species, including C. tropicalis, C. glabrata, C. krussei and C. parapsilosis, have been implicated in opportunistic infection of oral pharyngeal candidiasis. Previous researcher reported that the incidence of invasive fungal infections has been on increase since 1980, especially in the large population of immune compromised patients and those hospitalized with serious underlying diseases.

Candida species belong to the normal microbiota of an individual mucosal cavity, gastrointestinal tract and vagina and are responsible for various clinical manifestations from mucocutaneous over growth to blood stream infections. The yeast is commensal in healthy humans and may cause systematic infection in immune-compromised situation due to their great adaptability to different host niches. The genus is composed of a heterogeneous group of organism, and more than 17 different Candida species are known to be etiological agents of human infections. Reports have it that more than 90% of invasive infections are caused by Candida albicans, C. glabrata, C. tropicalis and C. krussei].

The expanding population of immune compromised patients that use intravenous catheters, total parental nutrition, invasive procedures, and increasing use of broad spectrum antibodies, cytotoxic chemotherapies and transplantation are factors that contribute to the increases in candidiasis. Pathogenicity of Candida species is attributed to certain virulent factors such as the ability to evade host defense, adherence, biofilm formation on tissue and medical devices, production of tissue-damaging hydrolytic enzymes.

Vulvovignal candidiasis is a prevalent opportunistic mucosal infection caused predominantly by C. albicans, although it is a virginal commensal. C. albicans can become a pathogen being a harmless infectious agent but in excessive growth could result in thrust characterized by intense irritation and soreness of the vulva accompanied by a thick, white chessy vaginal discharge. Growth of vaginal species is suppressed by other microbiota]. However, if anything upsets the normal microbiota, Candida may multiply rapidly and produce candidiasis.

Several studies had been done in many countries of the world. In Greek, a research was carried out to evaluate candidiasis among female population and pregnant women and C. albicans was isolated more often among the pregnant group. Also, in India, research was carried out to determine the frequency of Candida species in women of different age groups as well as to suggest the criteria for the diagnosis of vulvoviginal candidiasis. Of the diseases of public health concern in Nigeria is the prevalence of virginal candidiasis among women and so requires periodic attention at different domain.

This study therefore was carried out to evaluate the incidence of candidiasis amongst female students of a tertiary institution with the view too finding out the causes of susceptibility to the disease among students.
In Ogun State, particularly Babcock University the female undergraduates have not been spared by the above experiences of Candidiasis as records from the nearby health Centre show that at least 29 (43%) female undergraduates report with candidiasis every month.

Despite effort by the government and Non-government organizations (NGOs) to provide health services, there are still a number of candidiasis cases among Babcock University female undergraduates. It is due to this gap in which the researcher took the initiative to conduct this study so as to identify healthy education needs targeting the female undergraduates as regards candidiasis.


1.3 Purpose of the Study

Perceived factors associated with susceptibility to candidiasis among female undergraduate students in Babcock university


1.4 Justification of the Study

There is substantial evidence to suggest that Candidiasis is the second most common cause of vaginal inflammation after bacterial vaginosis(Berman, 2016). And its associated health problems have a significant economic impact on health systems and the medical costs associated with both direct and indirect costs. Direct medical costs may include preventive, diagnostic and treatment services related to Candidiasis, while indirect costs relate to loss of income from decreased productivity, restricted activity and absenteeism.

This study finding will provide data on the prevalence of candidiasis in the study area thus; it will be beneficial in the following ways:

i. Community:

The study finding will be used to improve on the knowledge and practices of female undergraduates on the prevention and management of candidiasis.

ii. Nursing Education:

The finding may also be used by Health tutors and other students as reference in similar future studies.

iii. Nursing Practice:

Intervention are always planned based on known problems, the findings of this study therefore will help the nurses in proper planning of their interventions.

iv. Nursing Research:

The finding will increase on the available information about Candidiasis.


1.5 Study Objective

1.5.1 General Objective

The general objective is the perceived factors associated with susceptibility to candidiasis among female undergraduate students in Babcock university

1.5.2 Specific Objectives
  1. To ascertain the knowledge about the causes of Candidiasis among the female undergraduates of Babcock University in Ogun State.
  2. To find out the practices of female undergraduates contributing to candidiasis among the female undergraduates of Babcock University in Ogun State.

1.6 Research Questions

  1. What is the level of awareness about Candidiasis among the female undergraduates of Babcock University in Ogun State?
  2. What are the practices of female undergraduates contributing to Candidiasis among the female undergraduates of Babcock University in Ogun State?

1.7 Research Hypothesis

  • H0 There is no significant effect of perceived factors on susceptibility to candidiasis among female students
  • H1 There is significant effect of perceived factors on susceptibility to candidiasis among female students

1.8 Significance of the Study

The study explored the perceived factors associated with susceptibility to candidiasis among female undergraduate students in Babcock university. Though the scope of the study was limited to the female undergraduates, it is hoped that the exploration of this group of women will provide a broad view of the susceptibility of candidiasis. The main importance of this study is that it will provide government and health workers recommendations to policies on ways to reduce the prevalence of candidiasis among undergraduates and the entire female populace at large.


1.9 Definition of Terms

Dysuria:

Discomfort during urination.

Species:

A group of organisms which live eat together and have similar characteristics.

Probiotics:

Are defined as live microorganisms that are believed to provide health benefits when consumed.

Candidiasis:

Infection with candida, especially as causing oral or vaginal thrush.

Vaginitis:

Is the inflammation of the vaginal wall resulting into discharge, itching and pain.

Dyspareunia:

Discomfort during sexual intercourse.


1.10 Organization of the Study

This paper is arranged in a way which sequentially answers the questions raised under the introductory part. Thus there would be five chapters in which Chapter One deals with introductory aspects namely, background of the study area, Objectives of the study Statement of the problem, Significance of the study, scope of the study and limitations throughout this paper. Chapter two would be dedicated to the review of related literature consisting scientific review and empirical review. Chapter three covers the methods used during data collection and data analysis. Chapter four includes finding and discussion part of the study. The last chapter incorporated the conclusion and recommendation part of the research.


1.11 Limitations of the Study

  1. The poor climatic condition that is to say rain interference, the researcher overcame this limitation by carrying out data collection procedures in the class rooms during rainy days.
  2. Hesitation by some respondents to give the required information, the procedure was explained to the respondents very well and guided to give all the required information.
  3. The researcher also encountered the financial constraints; the researcher overcame this limitation by strictly following the budget.

Chapter Five


Discussion of Findings, Conclusions and Recommendations

5.0 Introduction

This chapter presents discussions, conclusions and recommendations of the study findings. The discussions were arranged in themes for easy follow up and how the issues were being noted and presented in chapter four and where possible were compared to the results of relevant studies of the similar nature.


5.1 Discussion of Study findings

5.1.1 Social – demographic characteristics of female undergraduates at Babcock University

The study findings revealed that, the highest percentage of respondents (55%) was in the age group of 15.0-19.0, followed by (42%) in the age group 10.0-14.0 while the least percentage were of age group 20.0-24.0 with 3%. This was because majority of the respondents were between age group 15.0-19.0 and least number of respondents were among age group 20.0- 24.0. This implies that age is a very important factor in the causation of some diseases.
About the religion, the results indicated that, Christians formed majority with 42 (70%)respondents followed by Muslims with 18 (30%) respondents.

On marital status the findings showed that, all respondents 60 (100%) were single. This was because all the respondents were young school female undergraduates. There was significant statistical relationship between the prevalence of candidiasis and the social demographic characteristics among female undergraduates at Babcock University.

5.1.2 The level of awareness about Candidiasis among female undergraduates at Babcock University

On awareness about candidiasis, a majority of the respondents, (80%) had ever had about Candidiasis while (20%) had never had about Candidiasis. This implies that either majority of female undergraduates had ever been affected by candidiasis or had been informed by a friend or got information about candidiasis through a health talk while at school. Apparently there were no study references indicating the knowledge about candidiasis.

It was also found that, more than half 28 (58%)of respondents knew that candidiasis was a disease got through sexual transmission, while 16 (33%) of the respondents knew that it was a disease got through both poor personal hygiene and sexual transmission while only 4 (8%) of the respondents knew that it was a disease of poor personal hygiene. These results imply that at least all the female undergraduates knew the modes of transmission of candidiasis. According to CDC, 2015 CANDIDIASIS is generally not considered an opportunistic infection and unlike trichomonas vaginitis, it is not considered a sexually transmitted disease because candida spp are considered as normal flora in the vaginal tract and only becomes disease when the vaginal environment is disrupted with human practices like use of antibacterial soaps, multiple sexual partners, poor personal hygiene, prolonged use of antibiotics, oral sexual habits and immunosuppression.

It is also worth to note that, 48 (80%) respondents knew that the cause of candidiasis was fungal infections, 8 (13%) respondents knew the cause as bacterial infections while the least 4 (7%) of the respondents knew the cause as viral infections.

Another finding revealed that, a large proportion (75%)of the respondents knew that candidiasis was a disease associated to HIV and diabetes while (25%) knew it as being associated to malaria and ring worm. This was consistent with results from the research by (sobel 2007) which showed that HIV and diabetes had a relationship with candidiasis.

In related findings, a majority 40 (67%) of the respondents knew the signs and symptoms of candidiasis as itching around the private parts and whitish vaginal discharge, 12 (20%) of the respondents knew of headache and abdominal pain while the least 8 (20%) of the respondents knew of stomach ache, fever and diarrhoea as signs and symptoms of candidiasis. These findings imply that the female undergraduates were informed about signs and symptoms of candidiasis and would easily relate and differentiate symptoms of different diseases. According to (Achkaret al, 2010) Candidiasis is characterized by curd-like vaginal discharge, itching, and erythema.

About the risk factors contributing to candidiasis, a majority 50 (83%) knew that poor personal hygiene, multiple sexual partners, use of soaps for douching and prolonged use of antibiotics would predispose one to candidiasis, 8 (13%) knew that sleeping under mosquito net and handshaking would expose one to candidiasis and the least 2 (3%) knew that kissing and putting on closed shoes would expose one to candidiasis. Majority knew the risk factors for candidiasis because female undergraduates get health education from staffs at the health centre and also they have a school nurses who usually educates them about health issues. Sobel, 2015 in his study urged that while infections may occur without sex, a high frequency of intercourse increases the risk. Personal hygiene methods or tight-fitting clothing, such as tights and long underwear, do appear to increase the risk.

5.1.3 Practices contributing to Candidiasis among female undergraduates at Babcock University in Ogun State

In this study, most respondents 45 (75%) douched 1-2 times per day, 10 (17%) douched 3-4 times per day and the least 5 (8%) douched 5-6 times per day. The highest percentage of female undergraduates douched 1-2 times a day because of the society’s norms and being students they only get time during morning and evening hours while going to class and the few who douched 5-6 times may be because of the religion. Some were Moslems and usually clean up when going for prayers.

The results in figure 7 show that, a majority (75%) of the respondents use laundry soap followed by those who use plain water with (17%) and the least were those who use medicated soap with (8%). Most use laundry soap because of society and affordability and least respondents use medicated soap because they can afford it. Some use plain water because they may be aware that it the best option.

As shown by results of Table 5,50(83%)of the respondents hanged their towels 1-2 times a week while those who hanged their towels 3-4 times and 4-5 times all tied at 5 (8%). Hanging of towels dries the moisture in the towels which prevents fungal yeast from germinating on the towel.

According to figure 8, the study findings revealed that (83%) of the respondents put on cotton made knickers while (17%) of the respondents put on nylon made knickers. Cotton made knickers help to absorb water and reduce the suitability of environment for fungal infection to grow.

In table 6, among 60 respondents, 45 (75%) would use cotton under ware, loose fitting clothing, good personal hygiene and avoiding sharing clothes to prevent contracting CANDIDIASIS, 10 (16.7%) would sleep under mosquito net and 5 (8%) would avoid sharing clothes and sharing food with affected person to prevent themselves from contracting candidiasis.

In this study, significant results also showed that more than half 35 (58%) of the respondents had ever been diagnosed of candidiasis while 25 (41.6) had never been diagnosed of candidiasis. This was lower because a majority of the respondents were still young in comparison with the findings ofCDC, 2015 which affirmed that about (75%) of women are diagnosed of candidiasis in their life time.

Figure 10 shows that the highest percentage of respondents (74%)had not done tests to confirm candidiasis among those who had ever been diagnosed of candidiasis while only (26%) of the respondent had ever done tests to confirm candidiasis. This was high because Health centre does not do tests to confirm diagnoses of candidiasis rather the clinician bases judgment upon the clinical signs and symptoms to diagnose candidiasis, this finding correlated with Sobel, et al, 2015 who documents that majority of candidiasis cases are often clinically diagnosed based on signs and symptoms and are not confirmed by microscopic examination or culture. In addition, the widespread use of over-the counter antimitotic drugs make it easy for female undergraduates to access drugs without fully being tested.

Lastly the results showed that, of those who had ever been diagnosed of candidiasis (80%) would not take full treatment while only (20%) among those diagnosed would take full treatment for candidiasis. Very few respondents took full treatment for candidiasis when diagnosed this is attributed to the lack of money to afford treatment or poor attitudes towards drugs and treatment.


5.2 Conclusions

The following were drawn as the main conclusions from the study:

  1. All the socio-demographic characteristics of female undergraduates (age, marital status, religion and educational level) had some influence on female undergraduates’ practices towards the occurrence of candidiasis. There were relationships between social-demographic characteristics and prevalence of candidiasis at Babcock University.
  2. Most of the female undergraduates had some awareness about candidiasis, from findings of figure 3,(80%) of female undergraduates had ever had about candidiasis, from findings of table 2, (80%) of the respondents knew the cause of candidiasis and from findings of figure 5 that(75%)of the female undergraduates knew that HIV and Diabetes had a relationship with candidiasis. Lastly (83%) of female undergraduates knew that poor personal hygiene, multiple sexual partners, use of soaps for douching and prolonged use of antibiotics would predispose one to candidiasis.
  3. Majority of the respondents had good practices towards the prevention and reducing the prevalence of candidiasis, findings of figure 6 show that (75%) of the respondents had good douching practices, table 5 show that (83%) of the respondents would hang their towels at least 1-2 times, figure 8 shows that (83%) put on cotton made knickers while figure 10 shows at least (26%) do tests to confirm candidiasis before taking treatment. However, some respondents had bad practices as shown in Figure 7 that (75%) of respondents use laundry soap for douching, figure 10 shows that (74%) do not do test to confirm candidiasis before taking treatment while table 7shows that (80%) do not take full treatment when diagnosed of candidiasis.
  4. From the findings of the data analysis, the two study questions, level of awareness about candidiasis and practices of female undergraduates contributing to candidiasis among the female undergraduates of Babcock University in Ogun State were fully answered.

5.3 Recommendations

To Health Centre

There is great need for health education to explain to the female undergraduates’ issues concerning their health.

This should be done at least twice in every semester

  1. The health centre should also emphasize proper test and confirm the diagnoses of diseases before giving treatment.
  2. The health centre should also emphasize on full treatment for the diagnosed cases.
To the Community
  1. All females, irrespective of their age, tribe, marital status, religion, educational level and employment status, should be encouraged to make visits for prompt tests, diagnosis and treatment of candidiasis.
  2. Public forums should be used as a channel to promote good health habits. These include churches, community Sacco’s and development groups.
To the government
  1. Staffs in the Ministry of Health in the department of Public health who are concerned with reproductive health should be more aggressive in implementing existing policies.

5.4 Recommendations for Further Research

  1. Research beyond descriptive study (qualitative) is needed, for example a research including teachers and the whole female staff and also including many other schools should be done.
  2. A similar study may be done in a different geographical and cultural setting incorporating factors like pregnancy and effects of HIV and Diabetes that were not captured in this research.

Perceived Factors Associated With Susceptibility To Candidiasis Among Female Undergraduate Students In Babcock University


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Perceived Factors Associated With Susceptibility To Candidiasis Among Female Undergraduate Students In Babcock University


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